Permit A d, CITY OFTIGARD
— , . � � � ,,, DEVELOPMENT SERVICES PLUMBING PERMIT
� I
PERMIT # • PLM97 -0358
. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 08/28/97
PARCEL: 2S1O3BD —HGO35
SITE ADDRESS...: 12554 SW 115TH AVE
SUBDIVISION • HUNTER'S GLEN ZONING: R -4.5 PD
BLOCK • LOT -035 JURISDICTION: TIG
CLASS OF WORK.. :ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •SF WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP.. :R3 FLOOR DRAINS • 0 TRAPS • 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS : 0
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES : 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0 eC PIRE®
Remarks: Installation of backflow prevention device.
Owner: FEES
LEGEND HOMES type amount by date. recpt
6900 SW HAINES ST PRMT $ 15.00 DRA 08/28/97 97- 298724
TIGARD OR 97223 5PCT $ 0.75 DRA 08/28/97 97- 298724
Phone #:
Contractor .
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS OR 97113
Phone #: 647 -5567 $ 15.75 TOTAL
Reg #..: 000057
REDUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backf low Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final I n s p e ct i o n
applicable laws. All work will be done in accordance with
approved plans. This peruit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 % '%1-0010 through OAR 952 -0001 -0080. You lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued B •Z.dV Permittee Signature: _A.,. 0, I ,! ALL.
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
::ITY OF TIGARD Plumbing Application Recd By 2d/a
• 3125 SW HALL BLVD. Commercial and Residential Date Redd `�`�
TIGARD, OR 97223 Date to P.E.
503) 639 -4171 � � � Pete
Permiit t i DsT( 9 7 o35g
Print or Type ® Related SWR e
Incomplete or illegible applications will not be accepted Called
Name of Development/Project :Fl7CTURES pndtvidtlal
Job au +e... 651e‘...,_
Sink 9.00
Address Street Address Suite lavatory
9.00
Z5S j „, f : _ Tub or Tub/Shower Comb. 9.00
B g
ill
Zip Shower Only 900
eLD"/ op l `J' 72 Z.- water Closet
y� ‘../ s.00
e. �70i+••E' Dishwasher 9.00
Owner mss Suite epos 9.00
9 Machine 9.00
City/State Zip Phone Floor Drain 2 9.00
Name 3 9.00
4 ' 9.00"
Occupant Address Suite water heater
• _ 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal
9.00
Name Other Fixtures (Specify) 9.00
.� l i . .5! .. •e e. . S 9.00
Contractor Address Suite . 9
0 �C) 9.00 ` ...__
(Prior to issuance t � r y/State Zip Y 7/3 Phone -
applicant must A0 4 k r / r oV '° 3 ty7 ..675 9
provide all Oregon Const. Cont. Board tic.* Ex . Da - 9.00
contractors // 4 t) 5-, . r / 7E) .. 9.00 _-
license Plumbing Uc. S Exp. Date Sewer- 1st 100' _ 30.00
information -.6rS t,
b Sewer - each additional 100' 25.00
for COT COT Business Tax or Metro i Ex Date
database). water Service - 1st 100' 30.00
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Or Ma +g Address Suite Slam & Rain Drain - each additional 100' 25.00
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Mobile Home Space 25.00
Engineer ay /State Zip Phone Pollution Devi l Back Flow Prevention Device or Anti- 25.00
ce -ssaribe work New 0 Addition 0 Alteration 0 Repair 0 Residential Beddow Prevention Device* 15.00
ne done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture
:ditional description of work 9.00
Catch Basin 9.00
. _ Insp. of Existing Plumbing - 40.00
per/hr
.vsting use of Specially Requested Inspections 40.00
, u or property
Rain Drain, 30.00
single family dwelling 80 0
'roposed use of Grease Traps 9.00
building or property •
QUANTITY TOTAL
+re you capping . moving or replacing any fixtures? Yes ❑ No (3 isometric or riser diagram is required if Quanity Total is > 9 1''.4- i Z3 _ '
• Of yes see back of form) 'SUBTOTAL - ' - :
hereby acknowledge that I have read this application, - `• ir, On
■ PPUCation, that the information � . • : � � • .
riven is oorrect. that I am the owner or authorized agent of the owner, and 5% SURCHARGE ... :?.' - ':_ - : : - °" -
;
i ,
flat clans submitted are in compliance with Oregon State Laws. _-: .. , �
aigrature of r/Ag ` -- ;r •.;
���� �� Date PLAN REVIEW 25% OF SUBTOTAL E-2.7 12
Required only d fixture Pry. total is > 9 =
` TOTAL /5. 75
ary ct P rson Name Phone ;
'Minimum permit fee is 525 + 5% surcharge, except Residential Bacdkflow
Prevention Device, which is 315 + 5% surcharge
• I: \p(mapp.doc 12/96 ((1st)
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty ...:
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
•
;OMMENTS REGARDING ABOVE:
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1:\plmapp.doc 12196 (dst)
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing . Cover /Service FINAL:
Foundation k . ine Ceiling -Plumb.
Post/Beam Mech. Shear /Sheath -. Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: � A.M. P.M. Entry:
Address:J
Tenant: .l ZS Ste: MST:
BUP:
Con /Own: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
•
Inspecto . AU Date:
�� APEROVED DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION DIVISION MST 4 -tom 9
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -417
BUP
Date Requested _ AM M BLD
Location l S5 - I // 41/( i b� Suite MEC
Contact Person Ph PLM Q . 7 — O 3S 8
Contractor R(4%19-6 Ph (DZO RO8'o SWR
• • Tenant/Owner ELC
- - fining Wall ELR
Footing Access:
Foundation n n n FPS
Ftg Drain C i, .�i¢/j /1 J1 l�'/lt.J SF/9 SGN
Crawl Drain - Inspection Notes: C , o ib
Slab 1;61414A SIT
Post & Beam T , ` g _ 3Sg
Ext Sheath /Shear aco
Int Sheath /Shear
Framing
Insulation /
Drywall Nailing U / a . I it h At /L
Firewall
Fire Sprinkler
Fire Alarm , ////�/
Susp'd Ceiling i �-
Roof
Misc:
in:I
- • SS •ART FAIL
' LUMB `� -
_ ti/ J
Post & Beam /j i t / '�
Under Slab e / '
Top Out
Water Service
Sanitary Sewer
Rain Drains
ar Fig
PART FAIL
iLo HANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final Y
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final —
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA •
Approach /Sidewalk ✓ Date Inspector Ext
Other -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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